Today, I wanted to go through the most important exercise for a knee injury, especially if you have a meniscus injury.

Importance of the Terminal Knee Extension Exercise

The most important exercise for a knee injury is the terminal knee extension exercise. Doing the terminal knee extension exercise is important for almost any type of knee injury, especially meniscus injuries, ACL injuries (non-surgical and surgical) and knee replacements.

The exercise works on restoring end range knee extension movement, which is often lost with a knee injury. If you have a lack of knee extension, it will lead to other problems. For example, greater stress on the ankle and foot complex.

Let’s get to the video on performing the terminal knee extension exercise.

Avoiding Common Terminal Knee Extension Exercise Mistakes

Terminal Knee Extension with Tubing Exercise

Let’s go through the details of the exercise in the above video.

About the Resistance

In order to add resistance to the knee movement into knee extension, I am going to use resistive tubing. The tubing is fixed to something secure and should be checked for damage before using. As the exercise gets easier, I can increase the resistance of the tubing or move to a pulley machine for increased resistance.

Location of the Resistance

I have the resistive tubing above the knee joint – it shouldn’t be on the knee joint or below the knee joint. If the tubing was on the joint, it would put unnecessary stress on the joint, which you do not want during healing. With the resistance below the knee, it puts unnecessary resistance on the knee joint as well.

Load on Injured Leg

Now with this exercise, I am non-weight bearing on the injured leg (right). Most of my weight is on the left leg/knee.

Exercise Technique

I begin with the knee bent. I move from a bent right knee and press into the tubing until the knee is straight. I am not hyper-extending the knee but coming to a point where the hip-knee-ankle are in a straight line. The movement is done in a smooth and controlled manner.

Highlighting this point again, there is less weight on the right leg and in the above video, you can see that I only have light weight on the balls of my right foot and my right heels up.

I Have Seen This Exercise Before

You might have been given this exercise before or you might have seen it on the internet, but remember the level that I showed you is only one of the levels. There are lots of regressions, ones that are easier than this, and a lot more ways of progressing this exercise, making it a lot harder. I will go through some of them below.

Terminal Knee Extension Regression Exercise

Terminal Knee Extension Regression Exercise

This exercise is more on the early side of the knee injury rehabilitation continuum, and is a regression from the first exercise. You can do this exercise earlier in your or your client’s knee rehab program.

Set Up for the Exercise

Lay on a mat, but remember when getting on the mat, watch your kneeling. For some, kneeling might be difficult, so you can try doing this seated on a couch or seated on the bed.

For this exercise you can use a pillow or a rolled up beach towel, placed under your knee. What I used in the above video is a yoga block with a rolled up towel on top.

Execution of the Exercise

I begin with the knee in a bent position and then contract the quadriceps which leads to the leg straightening out. The movement should be done in a controlled and slow manner. Everything should be straight from the hip, knee to the ankle. This exercise activates the quads (VMO) and dynamically works on end range extension in the knee or terminal knee extension. Plus some people might feel a hamstring stretch when they perform the exercise.

Things that I watch out for are that the upper body is in a good position. If I have any kind of shoulder injury, I want to watch where the shoulder is. My arms are just behind my pelvis area. I don’t have them way back out here, because as soon as you pass 45 degrees of shoulder extension you will end up putting a lot more strain on the shoulder. (This article explains things more.)

This was a regression exercise. Now let’s look at a Terminal Knee Extension Progression Exercise.

Advanced Terminal Knee Extension Exercise

Background on The Above Exercise

A lot of times what you will find when you surf the net is people doing a tubing terminal knee extension. I want to show you a progression for that common exercise which is important, especially if you’re looking at overcoming your knee injury and getting back to running or walking.

Set Up of the Exercise

Begin by standing. Start with your right foot flat and the right knees are bent and soft. In the video above, I’ve got my hands on my thighs, and for the non-injured leg, which is the left one, I’m on the ball of my foot. I have the majority of my weight on that injured leg (right one).

Execution of the Exercise

Now, I am going to focus on terminal knee extension which is straightening that leg out until the knee is straight. We are looking at keeping the hip, knee and ankle straight.

I am going to straighten and then go back to the starting position. The movement is done in a slow, controlled manner.

Key Point to Remember

I’m looking down at my leg and I want to get visual input of where the knee is within space because a lot of times the proprioception (body’s ability to know where the joint is in space) of the knee ends up being lost and you need as much input as you can in order to know where that joint is within space so you don’t hyper-extend the knee.

The reason why I have my hands on the thighs is that I get more feedback, and I can relay back to my brain where my injured knee is within space.

Doing the terminal knee extension with resistive tubing around the knee is good, but what you need to do is start adding more and more load into that knee. You can see in the above video that the majority of my weight is on my injured leg, and the ball of my left foot is touching in order to keep balance. Adding more weight is important if you plan to walk or run.

That is it.

This is Rick Kaselj from exercisesforinjuries.com. Swing on by to exercisesforinjuries.com. There’s a whole bunch of information on exercises you can do for your knee injury or that you can get your clients to do. Also, there’s a knee injury guide on the site that you can download for free.